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This study investigates the role of leadership and cultural transformation in facilitating Lean Six Sigma (LSS) practices in clinical pharmacy settings to reduce medicine waste within the UK National Health Services (NHS).

A systematic literature review on Lean Six Sigma in health care was conducted to develop an analytical framework. This was followed by a qualitative case study of an English NHS trust to test the framework, exploring pharmacists' adoption of LSS practices and their impact on staff behaviour, focussing on leadership decisions and organisational culture.

The research highlights the significance of leadership’s prioritisation in waste reduction efforts and its influence on staff engagement. It also examines the intricate relationship between leadership decisions, education and training, resource allocation, and the prevailing clinical culture, which shapes pharmacists' behaviours and attitudes towards LSS practices and waste reduction.

The study’s focus on a single NHS trust limits the generalisability of the findings, suggesting the need for further research across different healthcare settings.

The study recommends a cultural transformation, earlier training, and reformation in service strategy to enhance the adoption of LSS practices and contribute to a more sustainable future for the wider health services.

Effective medicine waste management prevents harm and helps address the current NHS medicine shortage. The NHS can allocate resources efficiently, ensure timely treatment, and prepare for future disruptions by implementing the proposed framework.

We developed a leadership model for the NHS to reduce medicine waste, offering a novel approach to addressing the challenge of medicine waste through leadership and cultural transformation.